Korean researchers recently discovered a significant proportion of primary open-angle glaucoma (POAG) patients have minute-sized optic disc hemorrhages (micro-DH), which are associated with earlier and faster visual field (VF) progression.

This retrospective analysis included POAG patients with macro disc hemorrhages who met the following conditions: a follow-up period of seven years or longer (at least three years before and at least four years after the date of first macro disc hemorrhage) and more than nine reliable VF results. Micro disc hemorrhages were defined as a disc hemorrhage with an area less than 0.01mm2 that is undetectable on conventional stereo disc photography but can be discriminated by enhanced stereo disc photography. These photographs were enhanced by customized image-compensation software. Each enhanced image was evaluated to determine the presence of micro disc hemorrhages. VF progression was confirmed by standard automated perimetry's guided progression analysis.

Among the 107 POAG eyes with macro disc hemorrhages, the team detected micro disc hemorrhages prior to macro disc hemorrhages in 36.4% of eyes with a median time lag of 13.6 months. Over the course of 7.1 ± 0.8 years of follow-up, they found that 53.8% of the eyes with micro disc hemorrhages—but only 27.9% of eyes without micro disc hemorrhages—showed VF progression. In eyes with micro disc hemorrhages, they note that the cumulative VF progression probability was significantly greater and that the overall VF deterioration rate was much faster. 

Ha A, Kim YK, Baek SU, et al. Optic disc microhemorrhage in primary open-angle glaucoma: clinical implications for visual field progression. Invest Ophthalmol Vis Sci. 2019;60:1824-32.